Tuesday, September 01, 2009

I don't understand: US health care

Recently a US blogger spoke about how he was facing destitution because of the medical bills following the difficult birth and sickness of his first child.

We hear in the UK of United States citizens going untreated because of their poverty. That doesn't happen in the UK at the moment, except in the most extreme cases. For example, the husband of one of my parishioners, a few years ago, died because he was refused a second heart transplant, he was 42. The reasons were threefold, the degree of his illness, the difficulty of finding a compatible heart, and lastly the cost.

I can understand the fear of some US citizens, of a government imposing its own dystopian morality on its citizens but surely sick babies are aborted by poor mothers now because of fears of crippling medical bills. Would the mother of a child who was likely to be as disabled as Professor Stephen Hawkins be more likely to have him aborted under present US system than under the National Health Service in the UK?

26 comments:

I wonder how accurate are reports of refusal of care in the USA. As a child in conditions of poverty I can remember being in hospital in England before the introduction of the NHS. It cost my family nothing. However I have become accustomed to commentators saying that before the NHS medical care was not available for the poor. I wonder if the same commentators are any more accurate regarding the USA.

What is accurate regarding the USA is that medical bills are the biggest single cause of personal bankruptcy. That's bad for the healthcare provider as well as for the patient for, if the patient's assets are less than the bill, the healthcare provider doesn't get paid.

There IS medical care for the poor, more so than actually for an average citizen.

I grew up on welfare, and we wanted for nothing in the area of heathcare, whether preventative or emergency care.

However, our private health care system is ridiculously expensive and quite honestly, I won't go to the doctor unless I'm dying because I won't be able to afford the $500 deductible I'll have to pay, plus 20-30% or so OVER anything else.

The problem is the government is quickly trying to piece together a solution that actually hasn't been researched, they're trying to force on us, they're outright LYING about what's in the bill, and it's going to be worse, not better.

What really needs to happen is that private AND public companies need to be reined in, the costs need to be evaluated because they make NO SENSE, and we need to let doctors, not insurance companies, decide what a patient needs. AS it is, it's the companies deciding what is "worth the risk."

Father I would say the reports of refusal of care in the USA are unfortunately true. WHEN care is not refused then one gets a crippling bill that one if often unable to pay (Ive been in this situation myself). I lived in Germany for many years (as a US citizen working there) and I felt secure knowing that I could go to the Dr or in hospital if needed. There is an aversion in this country to anything that could even vaguely be considered "socialistic". Many do not want to have to have any hand in aiding to pay for someone else's health care or public transporation etc. I think Americans are far too individualistic. I would say ruggedly so. There is a saying I love among the Germans that we (as a society) are only doing as well as ALL OF US are doing well. I think Europeans tend to think more about WE and less about ME. just my thoughts.

The case of your parishinor's husband illistrates why many people in the US don't want socialized healthcare, NICE doesn't care how effective the medicine is or if it will save lifes, COST is the one thing they do care about. Daniel Hannan seems to be right when he advocates the singapore model. About the aborted children, I wonder how many would have gotton pregnant if they hadn't been subjected to the 'safe sex' message?

The US Bishops have objected to the proposals only because there is a clause in them which gives much impetus to free abortions. If that clause could be removed they would not complain. The US system as it stands is iniquituour in my opinion. I know the poor can get treatment by charity hospitals but that should not be needed in a civilised society.

It is a complicated issue, Father. On the one hand, over here we are hearing lots of ‘horror stories’ about the NHS in the UK and Canada – interminable waits for treatment, people dying in hospital corridors, treatments refused, etc. The other side trots out similar ‘horror stories’ about people here dying due to lack of care, being turned away from hospitals and being ‘too poor’ to get care.

I suspect there is some truth on both sides, but extreme cases are being touted to influence public opinion both pro and contra the proposed health care plan. For Catholics the biggest stumbling block is the provision for taxpayer-funded abortion and the real danger that the ‘conscience clause’ (allowing care-givers to opt out of immoral procedures such as: abortion and contraception - and allowing Catholic hospitals to refuse to engage in these…) will be excluded from the program.

Is health care overly expensive in the US? Certainly! At fault are the Insurance companies, the Drug companies and the Legal profession – and the Congress members to whom they contribute millions of dollars to ensure things stay the way they are. Insurance company rates are staggering. Drug prices are kept artificially high due to ‘patents’ which prevent open competition. When a patent is set to expire, a ‘new and improved’ version of the drug is produced, a new patent secured and the cycle begins again. Doctors have to have high-premium malpractice insurance due to the obscene awards for ‘damages’ that lawyers can secure from the legal system.

So to fix all of this we are to put health care in the hands of a government that was complicit in creating these conditions in the first place…? A government that is rife with waste and special-interest expenditures at tax-payers’ expense…? I don’t think so.

Servusmariaen, I spent a year in Germany as a student, and while I was there I had to spend a little time in hospital. I had to insure myself with the Allgemeine Ortskrankenkasse, at a quite modent premium which I was able to claim back in the UK with the E111 form.

Fogive me for coming back again on this topic, but I can understand why Americans distrust the NHS, an overcentralised bureaucratic organisation employing people on a scale exceeded only by the Chinese Army or the Indian railway system. However if you look at for example Spain it is possible to have an excellent health care system which avoids this extreme. There people obtain medical cover by being children, old, by means of their employment, or by health insurance. The latter is fairly cheap because so many people take it out. I was a member when I lived in Spain of a medical insurance scheme run by a co-operative of medical professionals, it was cheap and it included dentistry. Now that I am back in England dentistry costs much more. Provided that care is free , there is no necessity for its providers to be organised and owned by the state.

The British NHS was originally suggested by a Liberal, Lord Beveridge, it waa accepted in principle by the Wartime Coalition Government, and it was actually set up by Labour with Aneurin Bevan as the Minister of Health.

As an American living in an average size town with an average income--I would say the press is not accurate regarding US healthcare access. The US not only takes care of our citizens, we take care of illegal aliens' healthcare and we provide healthcare to Canadians and Europeans who desire the latest in care, techniques and medicines. The reports are skewed to fit an agenda. The 3 areas in which the Govt has taken over-Medicaid, Medicare and the Veteran's Administration--serve to provide as an example of how lack of competition results in disaster. Maybe having no competition works in other countries--it does not work here. We are, as a country, dealing with the results of a generation being raised believing they are "entitled" to everything--free--including healthcare. This has also taken many away from the family and the Church--who needs God when government will provide for everything?

And Fr. Clifton, as far as I am concerned the US bishops can take a long hike off a short pier.

You've been misinformed re: the state of US health anyway. When I was in my early 20s I'd had emergency gall bladder surgery. I was no longer under my parent's plan, but just out of college.

Far from being in a "charity hospital" the operation was done in one of the finest hospitals in the city, by one of the leading surgeons in the city for Internal Medicine. So, please. Put the lies to rest. They're lame.

we take care of illegal aliens' healthcare and we provide healthcare to Canadians and Europeans who desire the latest in care, techniques and medicines.

Don't the illegal aliens have tax deductged from their pay?

The Canadians and Europeans who come to the USA for health are those who can afford to pay.

The World Over with Raymond Arroyo on EWTN had a good overview of the proposed system.http://www.ewtn.com/vondemand/audio/latestadditions/seriessearchprog.asp?seriesID=-6892288&fldSeriesName=The+World+Over

The second WOL programme I listened to on the proposed Health Reform isn't in the archives yet.

With over 1000 pages to read on just one section of the health bill what average person is going to read it?

I'm sorry if I've overlooked anyone's previous comment on an important cause of high medical costs in America, which is the high cost of litigation. Having worked in insurance, and now, with attorneys, I've seen (and it seems to be common knowledge) that doctors and medical institutions face astronomically high medical malpractice insurance premiums, as well as pressure to perform many costly preliminary medical tests to pre-defend against lawsuits.

As far as being "rugged individualists," the idea of a State taking over the decisions about who may receive health care, runs counter to our belief that each individual has the right, the dignity, and the intelligence to make his own decisions. It is terrible to think that the State will make our decisions for us based upon how costly it is to give medical care to some genetically undesirable young, the very old, the handicapped, the very ill, and those who have passed their economically productive years.

By law, people are not denied healthcare in our emergency rooms, and if you have bills that can't be paid, a very, very small amount of money each month can be sent in to the hospital. Happens all the time.

There are many possible and practical ways to reform the American health system while at the same time avoiding a State takeover of our private health decisions.

What people outside of the US might not know is this... The poor are medically covered through Medicaid. The aged are covered through Medicare. Children can be covered through SCHIP. Additionally, there is charity care available in most areas from non profit or state run hospitals. Many people who are eligible for these programs are included in 'uninsured' statistics because they have not signed up yet.

Medical care is available to everyone. Some people just place their priorities elsewhere and choose not to purchase insurance (primarily young healthy people who play the odds). The thing is... we have the freedom to CHOOSE to not purchase insurance and then the responsibility to deal with the potential consequences.

In the past I was unemployed and I choose to purchase catastrophic care coverage. That meant that I had a high deductible (thousands of dollars) and I covered basic expenses (hospital visits etc) out of pocket. I was glad to have that option.

I think that a huge difference in the American way of dealing with medical care is the fact that we are a country that was settled and founded by self reliant individualists. There are many people here who still think that personal responsibility is key in dealing with health care.

The Catholic Church teaches that every adult worker is entitled to a just wage. In 1891 the then Cardinal Secretary of State issued a Responsum on three questions on wages.

One of the questions went like this:

QUESTION: Does an employer sin, and if so how, if using neither force nor fraud he pays a wage smaller than the work performed deserves and a decent standard of living requires, it being understood that that the workmen concerned take the jobs willingly and are satisfied with or freely consent to the wage?

REPLY: In the absence of any qualification, he sins against commutative justice.

The just wage is set according to the needs of a family, adjusted for overall affordability. The unadjusted amount is in the order of GBP 35,000 for a family of five including three teenagers. If you take the tax man out of it, two thirds of men in full-time employment earn less. 82 per cent earn less than the gross wage you need to clear that standard.

You don't need to look too hard to find that vast numbers of people are not only earning less than the just wage, they are also earning less than employers can afford.

Correct me if I'm wrong, Father, but the impression I get is that wage theft is a grave matter irrespective of the amount withheld.

I don't think there is much difference between the system we have in Europe and the system in the U.S. The NHS could be described as one extreme and the U.S system as the other with a considerable amount of ground in between.

For all that is said about the NHS, with the usual ode to socialism, All that is good about the NHS was already there before it's foundation; The Hospitals, Doctors, nurses, teaching hospitals etc. where already built and running very well (Britain was a world leader in medical care).

All the NHS did is to attempt what the US system is proposing, namely;1. Bring equality (and meadiocrity).2. Put in a large management structure to run these 'new' public hospitals. (one that has become ever larger)3. To try to save money (and fail)

So other points;Medical insurance in the U.S. is high because of the large level of defaults. i.e. you are paying more than you should because so many people fail to pay. The answer to this is not the NHS but regulation of the insurance industry!

Drug costs; these are high because of the large expense to produce these drugs, the companies also need to make a profit. Sadly the NHS has not used its vast resources to develop it's own drugs or to look in to for example, how changes of diet can sometimes be more effective than expensive drugs.(I have worked in the industry)

Providing Health care is a charitable ideal, charity starts in the homes and moves out to the local community. A large office block in Whitehall can never understand charity because it never 'sees' the individual and his needs.

The large office block (or blocks) distrust the individual doctors, and create red tape to keep them in check. This costs large amounts of money and is why the NHS needs its 'death panels' also known a N.I.C.E. to attempt to save money.

Our politicians have spent the last 50 years trying to fix the NHS and have failed, the U.S. is better off as they are.

Thomas, the reason why so many people fail to pay their medical bills is that they get bankrupted on them

And let's not wave the 'socialism' shroud when discussing the NHS or the public ownership question.

Pope Pius XI and John XXII were between them clear about the distinction between Christianity and socialism. The world view of socialism is bounded by time with no vision of any life beyond this one, and no affirmation that there is a human nature which is not endlessly malleable. So no inviolable bond of marriage, no natural purpose of human sexuality, no family wage due in natural justice, and no civil authority not founded on human convenience alone as opposed to man's social nature.

It sets before man the chief end, not of serving his Creator, but of producing for common ownership as much material wealth as possible, as efficiently as possible - and to this end he is to devote the whole of his life.

1) There are many people – typically cited as 47 million – without medical insurance.

2) The cost of health insurance continues to rise, with medical spending in the U.S. at $2.2 trillion in 2007, constituting 17% of the Gross Domestic Product, and predicted to double within 10 years. (Source: Office of Public Affairs, 2008: http://www.cms.hhs.gov/NationalHealthExpendData/downloads/proj2008.pdf).

3) The Medicare Trust Fund is predicted to be insolvent by 2019.

4) Mandated health insurance benefits for full-time workers have created an incentive for companies to hire part-time rather than full-time employees.

5) Similarly, the much higher cost to employers for family health coverage, as compared to individual coverage, places job candidates with many dependents at a disadvantage in a competitive market.

6) Individuals with pre-existing conditions who most need medical care are often denied the means to acquire it.

There are also perceived strengths of our current system:

1) Most Americans like the medical care services available to them. Our country, in some ways, is the envy of people from countries with socialized systems of medical care.

2) It is important to remember that 85% of citizens in the U.S. do have insurance. Forty percent of the uninsured are between 19-34 years old. (Source: Current Population Survey 2008 Annual Social and Economic Supplement) A 2007 study by the Kaiser Commission on Medicaid and Uninsured found that 11 million of those without insurance were eligible for Medicaid or SCHIP but were not enrolled. Those eligible but not enrolled include 74 percent of children who are uninsured. (Source: Characteristics of the Uninsured: Who Is Eligible for Public Coverage and Who Needs Help Affording Coverage?)

3) The competitive nature of our private sector system is an incentive to positive innovation and the development of advanced technology. Medical doctors and research scientists are esteemed. Doctors and other scientists immigrate to our country because of the better compensation given to those who provide quality medical care or produce successful research.

4) Medicare and Medicaid, while they have their limitations, provide an important safety net for many of the elderly, the poor and the disabled.

What Must We Do?

The justified reaction to the significant defects in our current health care policies is to say, “Something must be done.” Many believe: “We have to change health care in America.” Despite the many flaws with our current policies, change itself does not guarantee improvement. Many of the proposals which have been promoted would diminish the protection of human life and dignity and shift our health care costs and delivery to a centralized government bureaucracy. Centralization carries the risk of a loss of personal responsibility, reduction in personalized care for the sick and an expanded bureaucracy that in the end leads to higher costs."

As I'm from the US, I think I can shed a little light from my own perspective. First, by law, nobody is denied care here if they present themselves at a hospital emergency room. ER's are required by law to treat anybody that comes and makes the request. Second, most Americans have medical insurance. In my view, they should just leave those people alone. There is no need to overhaul the part of the system that is working. For those who do not have insurance, medical reform is needed. How about govt. sponsored medical savings accounts as one option or some type of change for those in need. Another point of personal experience, I wanted to mention is my sister, who was totally without funds, was diagnosed with a brain tumor. She applied for medicaid govt. funded, and she received the very best of care that is available anywhere in the world at no charge to her, so for those that are truly disabled, care is available. Under US law, those with huge medical bills currently can take medical bankruptcy, they don't have to go to the poor house for a catastrophic illness. In this case the medical bills are all written off by the court. The people who "fall thru the cracks" are mostly large families with little income, who need ongoing care. Could the system be improved? Yes. But no need to throw out the baby with the bathwater. And that doesn't even mention the issue of how were going to have a Dr. shortage if the new proposed plan goes through. US Doctors are not going to put up with having the govt. dictate every move they make, both medically and financially.God love you all! blessing from Texas!

Ubi Petrus, ibi ecclesia, et ubi ecclesia vita eterna

Pray for Francis our Pope, and for the Church of God

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